Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PS006274L | PA |
Y | 103T00000X | Psychologist | PS006274L | PA |
NPI | 1013056407 |
---|---|
Provider Name | Mr. Jeffrey Lynn Lensbower |
First Address | Chambersburg, PA 17201-1450 |
Second Address | Chambersburg, PA 17201-1450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 06/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0012960070001 | (05) | PA |
LE172614 | BLUECROSS BLUESHIELD (01) | PA |